| NPI | 1124055736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME79140) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 213076-1) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-06-02 |